CPMH's Opinion on the 21st Century Cures Act

A Message on the 21st Century Cures Act from James A. Smith, III, MD,
Medical Director of Carolina Partners in Mental HealthCare, PLLC

The 21st Century Cures Act was recently signed by President Obama, to both praise and scrutiny. Most think this act is related to cancer and Alzheimer’s disease, but deep into the 1000-page bill Congress went after the dilapidated state of our mental health system, allowing for many benefits to improve the current state of mental health treatment and research.

The first big change is that Congress accepted the fact that SAMHSA (Substance Abuse and Mental Health Services Administration) has failed individuals with serious mental health illnesses; wherefore, the bill establishes an assistant secretary for Mental Health and Substance Abuse to oversee SAMHSA. Many, including the National Alliance on Mental Illness, view this as a step in the right direction.

The act designates a new Interdepartmental Serious Mental Illness Coordinating Committee, which will be charged with summarizing advances in diagnosing and treating serious mental illness, and reporting to Congress; this group will also evaluate the impact of federal programs on public and private mental health services. The act specifically allows grants to local governments, which will provide funding to improve crisis intervention services and to build a registry of available inpatient psychiatric beds. The act increases training programs to foster “integrated care” as the most efficient model of health care — embedding mental health providers into the broader landscape of primary care. The act also includes funding for a nationwide hotline and an online tool for accessing mental health providers with greater ease. Crucially, the act will offer grants to address mental health accessibility for the homeless and those trapped in the criminal justice system, who have both been egregiously overlooked by the mental health system at large.

An inmate in the La Crosse County men's jail has little to do but rest in his cell in a jail-issued uniform. PETER THOMSON photo

This act does not amend HIPAA, but it does improve a clinician’s ability to share information with a patient’s family. It also promises to go after insurers who skirt around the Mental Health Parity Act to avoid covering mental health care services. The act also will improve and enforce information interoperability within electronic health systems, improving patient care nationwide.

Carolina Partners stands ready to move forward as one of the few private practices that accept insurance, assisting thousands of patients each year who would otherwise have very limited access to quality mental health services. While the 21st Century Cures Act contains no magic within its pages, it is an important step in reforming a broken system that has excluded so many with a serious mental illness — shunting people out onto the streets and into our prison system — while closing hospitals and withholding much needed funding from our communities. We stand in full support of this act — let’s give it a year!

January Focus: Mental Wellness in the New Year

It's a new year, and a new chance to intentionally care for your mental health!

First thing's first. Remember that with the beginning of the new year, it is normal to feel tired from the holidays. The holiday season is a time of lots of joy, but also lots of busy-ness and stress. Often people feel societal pressure to jump back into work with boundless energy in the new year. But pace yourself! And be kind to yourself. Remember that just because we all are returning from a holiday "break" doesn't mean that we actually got a break. Many of us will return to work in the new year feeling tired and unprepared to start back at work. Be aware of your own expectations entering the new year. And be aware of the expectations of others. Practice self-loving and give yourself time to achieve small tasks and rest as you ease into 2017.

The end of a year is a great time to take stock of where we are and to set goals for what we next want to achieve. As you think about possibilities for your own new year's resolutions, remember to consider your mental health! Here are some tips for factoring mental healthcare into your coming year.

1. Set specific, measurable goals.
When working towards a goal it is important that we facilitate our ability to see change and to see the results of our efforts. By setting specific goals, you will be more likely to reach them. By setting measurable goals, you'll be more likely to congratulate yourself for your progress. So, for example, instead of setting a goal to, "Exercise more," consider making that goal more specific. You could, "exercise for 30 minutes three times a week, doing any activity." And then you could put a chart on your fridge where you mark each day that you complete your goal. Achieving your goals and congratulating yourself on your progress are two ways to dramatically benefit your mental wellness.

2. Have realistic expectations.Another important aspect to mental wellness in the new year involves setting realistic expectations. For example, if you've never before successfully run a mile, then it's unrealistic to expect that you'll be able to run a marathon this year. Instead, you could set a goal to run a mile within two months, two miles within four months, etc. Then, you can further break down your goal into weekly and even daily goals. Setting realistic expectations likewise benefits your mental wellness by allowing you to work towards a goal that is possible to achieve without hurting or overextending yourself.

3. Practice self-compassion.Practicing regular self compassion is one of the most impactful strategies for mental wellness. Pay attention to the way you talk to yourself. You could, for example, take ten minutes a day to check in with yourself and bring awareness to your internal dialogue. Often we walk around all day with a very mean, very harsh inner voice--a voice who says things we'd never dream of voicing to a loved one. And yet we say these things to ourselves often. Statements like:
"You're lazy."
"No one really loves you."
"You're lame and stupid and everyone else sees it but you."

Once we take the time to intentionally bring awareness to our inner dialogue, we then have the option of countering this hurtful inner dialogue with statements of self-compassion. For example, if your inner critic says, "You don't work hard enough," you can counter that with a statement of self-compassion such as, "You're tired after the holidays. Give yourself some space to recover from a busy time." Or, if your inner critic says, "No one really loves you," you might counter that with a statement of self-compassion such as, "Wow, you are really scared that no one loves you and that you'll end up alone. I hear you and that sounds hard."
By practicing even small acts of self-compassion, we can dramatically benefit our own mental wellness.

4. Engage in activities that you know make you feel good.
Sometimes in the new year, people can get too focused on re-inventing the wheel. New Year's resolutions don't need to be original or new to you in order to improve your life. We are each the incomparable expert on ourselves. No one knows you better than you do. So what do you know makes you feel good? For example, maybe every time you go on a walk that's 20 minutes or longer you notice that your mood improves, even if only slightly. By noticing this pattern you can incorporate more walks into your new year. Be honest with yourself. Set goals from a place of honesty and alliance with yourself. If, for example, you know that you dislike the taste of kale, then don't set a nutrition goal to eat more kale. Why force yourself to do something you know you don't enjoy? Instead, think about other foods you could eat to get the same nutritional value as you do from kale. Or, if you know you love swimming, then why set a goal to learn a new sport? Instead, focus on refining and encouraging what you already know you enjoy. New Year's resolutions don't have to be hard; they can be fun!

Good luck! And let us know how you do! We would love to hear from you on how you're approaching the new year.

We want to hear from you! Please comment below.

What are your New Year's resolutions?
What are your strategies for setting goals?
How do you practice self-compassion?
Which types of goals feel the best to you and why?
When have you been most successful with your New Year's resolutions?